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Purpose: Arthroscopy is an efficacious and popular treatment modality in the United States and other developed nations for a variety of musculoskeletal conditions and injuries. However, arthroscopy requires specialized training, complex infrastructure, and expensive equipment causing barriers to use in developing countries. As a result, the utilization of resources to teach and perform arthroscopy in developing countries is controversial. Through this investigation, we assessed the current capacity and barriers for arthroscopy and arthroscopic training in such settings.
Methods: Focus interviews were conducted with four surgeons each from Haiti (low-income nation) and Romania (middle-income) regarding their experience with arthroscopic surgery. Based on the responses from the interviews, a multiple-choice survey instrument was developed to analyze the existing capacity for arthroscopy in these nations, as well as challenges and needs for further development and training. Surveys were administered to orthopaedic trainees and practicing orthopaedic surgeons during national orthopaedics conferences in each country.
Results: The survey was completed by 58 orthopaedic surgeons in Haiti and 29 in Romania. Seventy-seven (89%) were male and ten (11%) female. Most (91% from Haiti; 95% CI: 0.84 – 0.98, and 79% from Romania; 95% CI: 0.64 – 0.94) reported that learning arthroscopy is essential or important for orthopaedic training in their country. However, while 69% from Romania (95% CI: 0.52 – 0.86) indicated that their primary hospital has the equipment necessary for arthroscopy, 83% from Haiti (95% CI: 0.77 - 0.95) indicated they are lacking equipment. In Haiti, equipment was the main barrier followed by training, while in Romania, training was followed by equipment. Simulations and telemedicine were listed as top choices of effective methods for learning arthroscopy.
Conclusions: Our results show that an overwhelming majority of participants, regardless of the resource limitations of their country, place a high value on the practice of arthroscopy in orthopaedics. The demand for these techniques requires a supply of functional equipment and specialized training which have been inadequate up to this point. The results from this study highlight a hierarchy of needs in developing nations. By identifying similarities and differences in the capacity, needs and barriers in different locations, we may better tailor global orthopaedic training initiatives and partnerships in low- and middle-income nations. |
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